ulceration. Caries and necrosis of the tympanic walls may be present,
associated with facial paralysis and labyrinthitis.
Labyrinth and Eighth Nerveó'Neurolabyrinthitis*
In the early stages of syphilis there is often a pleocytosis in the cerebrospinal
fluid along with an increase of albumin, i.e. a luetic meningitis. In secondary
syphilis complaints of tinnitus, giddiness and disturbance of balance are
by no means rare. In some there are changes in the posterior cranial fossa,
as evidenced by nystagmus of central origin and cerebellar disturbance of
balance. These cases nearly all show definite changes in the cerebrospinal
fluid, i.e. positive serological tests and increased cell count. Deafness is
sometimes of sudden onset, but may be gradual. As a rule only one ear is
involved. Functional examination shows an inner ear deafness and micro-
scopic examination of the labyrinth reveals atrophy of Corti's organ and
its ganglion cells.
Tertiary Affections of the Eighth Nerve
The eighth nerve may be affected along with other cranial nerves by gum-
matous infiltration of the meninges and nerve sheaths. These conditions
are often preceded by severe headache, sometimes of long duration. Head-
ache of syphilitic origin is worst at midnight while that of nasal origin is
most severe in the forenoon. In cases of nerve deafness serological tests
may be positive.
TREATMENT. Treatment of acquired and congenital syphilis is by large
doses of penicillin to control the infection, but only limited improvement
in the symptoms can be expected.